Central Cord Syndrome: A Review of Epidemiology, Treatment and Prognostic Factors

Introduction: Traumatic central cord syndrome is the most common clinical syndrome encountered in the setting of incomplete spinal cord injury and is vaguely defined as by disproportionately more impairment in the upper than the lower extremities. Methods: A MEDLINE database search was conducted to review the epidemiology, treatment and prognostic factors of this clinical entity. Results and Discussion: Central cord syndrome typically occurs in white, middleaged men. Symptoms can be mild to severe, ranging from burning of hands and feet to disproportionate weakness of the upper extremities, variable sensory loss and bladder or bowel dysfunction. The pathogenic mechanism can involve fractures, dislocation and disc herniation caused by hyperextension or flexion injuries of the cervical spine. The prognosis is benign in most cases and the majority of patients, particularly the young, have a high recovery rate. While there is a trend towards surgical intervention in the United States, the management of this syndrome remains controversial due to weak and conflicting evidence. Several prognostic factors have been described, including age and baseline neurologic function. Studies on blood tests and electrophysiological measurement show promising results in predicting a favorable outcome. Conclusion: There are currently no evidence-based guidelines for surgical treatment or the timing of intervention. Future research, conducted as prospective trials of large populations, may provide further insight into this vaguely defined entity.